Horace Roman

Université de Rouen | UR

Study objective: To highlight the anatomic keys in order to perform safely an excision of deep endometriosis nodule of sciatic nerve DESIGN: We present a didactic video combining: an anatomic three-dimensional reconstruction of the pelvis using the Anatomage® table and a surgical dissection video of the removal of deep endometriosis nodule of the...

Study objective: To describe the robotic full-thickness rectal excision using a transanal circular stapler in rectovaginal endometriosis nodule infiltrating the rectum over 3 cm. Design: Surgical video article. The local IRB was consulted and ruled that approval was not required for this video article, because the video describes a technique and...

Objective: Deep endometriotic lesions may involve the deep parametrium which is highly vascular and includes numerous somatic and autonomous nerves (1,2). Surgeons who dissect in this area, must always be prepared to deal with major bleeding, and to master the different techniques of hemostasis. The goal of this video is to show the steps of lapar...

Endometriosis nodules of the low rectum and vagina are a challenging localisation of deep infiltrating endometriosis. Various surgical approaches can be utilized to safely excise them. Our patient presented with a symptomatic rectovaginal endometriosis nodule with bilateral parametrial involvement and left‐side extension to S3 sacral root. We perfo...

Endometriosis is a common gynaecological disease, causing symptoms such as pelvic pain and infertility. Accurate diagnosis and assessment are often challenging. Transvaginal ultrasound (TVS), along with magnetic resonance imaging (MRI), are the most common imaging modalities. In this narrative review, we present the evidence behind the role of TVS...

Training and education in diagnosis and therapy of endometriosis.

Study Objective To report a large series including women managed by disk excision using end-to-end anastomosis (EEA) circular transanal stapler to assess the feasibility of the technique, the features of nodules suitable for removal by disk excision and the rate of major early complications. Design Retrospective study on data prospectively recorde...

Objective To present different approaches used in the surgical management of diaphragmatic endometriosis using the Davinci Robotic system. Design A video article presenting patient positioning, port placement, and surgical techniques used in robotic excision of diaphragmatic endometriosis with concomitant pelvic disease. Setting Endometriosis cen...

Study Objective To compare postoperative complications and rectovaginal fistula rate in women undergoing excision of large rectovaginal endometriosis requiring concomitant excision of rectum and vagina during two time periods with differing policies for preventive stoma confection. Design Retrospective before-and-after comparative cohort study on...

Objective To compare first-line surgery with first-line assisted reproductive techniques (ART) in infertile women with deep infiltrating endometriosis (DIE) without colorectal involvement. Study design: A retrospective comparative cohort study with a propensity-score matching analysis, in four tertiary-care referral centers. The population was infe...

Study objective: To evaluate the impact of laparoscopic sclerotherapy on the management of endometrioma during surgery for deep infiltrative endometriosis (DIE). Design: Observational study SETTING: Tivoli-Ducos Clinic, Bordeaux. Patients: Sixty-nine patients underwent laparoscopic sclerotherapy for endometrioma during surgery for DIE. Interv...

Objective The present work aimed to investigate the feasibility, complications, recurrence rate, and infertility outcomes of the radical and conservative surgical methods for colorectal endometriosis in short- and long-term follow-ups. Methods In this prospective study, the patients with confirmed diagnosis of colorectal DIE were included from Mar...

Background and aim: Irritable bowel syndrome (IBS), eating disorders (ED) and endometriosis share common pathophysiological mechanisms, involving alterations of the gut-brain axis. The aim of the ENDONUT pilot study was to investigate an association between these three diseases by screening for IBS and ED in patients with endometriosis. Method:...

Objective: To compare differences in the postoperative pregnancy rate in women seeking to conceive and presenting with endometriomas larger than three cm diameter, which were managed by ablation using plasma energy, cystectomy, or simple drainage. Methods: A retrospective three-arm comparative study based on prospective collection of data evalua...

Study Objective To describe our experience with the use of Natural Orifice Specimen Extraction (NOSE) technique for segmental bowel resection in patients with colorectal endometriosis. Design Retrospective, observational study. Setting Single tertiary referral centre Patients 50 consecutive patients undergoing NOSE colectomy for colorectal endom...

BACKGROUND Chronic pelvic pain is a frequent debilitating condition in women suffering from endometriosis. Pharmacological and surgical treatments are not always efficient in controlling pain and present important restriction. Digital Therapeutics (DTx) are emerging as major non-pharmacological alternatives, aiming to extend the analgesic therapeut...

Background Chronic pelvic pain is a common and disabling condition in women living with endometriosis. Pharmacological and surgical treatments are not always effective at controlling pain and present important restrictions. Digital therapeutics (DTx) are emerging as major nonpharmacological alternatives that aim to extend the analgesic therapeutic...

Surgical management of rectal endometriosis may employ two approaches: (i) conservative, with the preservation of overall rectal shape by either shaving or disc excision and (ii) radical, by segmental colorectal resection. There are numerous retrospective case series, a few comparative cohorts with prospective recording of data, as well as a random...

Transvaginal sonography is the first-line imaging technique to diagnose endometriosis, but magnetic resonance imaging is more accurate in staging the extent of lesions, especially for deep pelvic endometriosis. The revised American Society for Reproductive Medicine and Enzian classifications are commonly used to stage the extent of endometriosis. H...

Introduction Deep infiltrating endometriosis (DIE) affecting the rectum or sigmoid colon is associated with infertility, severe pain and decreased quality of life. As most women with DIE are young, many have a pregnancy intention. Treatment possibilities of endometriosis-associated infertility are surgery or assisted reproductive technologies (ART)...

Summary Objective : To present 10 standardized steps of the surgical management of diaphragmatic endometriosis using Da Vinci robotic assistance. Design : Surgical education video. The local IRB confirmed that the video met ethical criteria required for publication. Patient consent was obtained. Setting : Tertiary referral center Intervention : The...

Objective To present 10 consecutive, standardized, and reproducible surgical steps for laparoscopic sclerotherapy of an endometrioma. Design Step-by-step video demonstration of the technique. Local institutional review board approval was not required for this video because patients cannot be identified. Setting Endometriosis Center. Patient(s) W...

Study Objective To compare functional outcomes, recurrence rate and pregnancy likelihood in patients undergoing conservative or radical surgery in patients with deep rectal endometriosis 7 years post-operatively. Design Prospective study in a cohort of patients enrolled in a 2-arm randomized trial from March 2011 to August 2013. Setting A tertiar...

Introduction et but de l’étude Le syndrome de l’intestin irritable (SII), les troubles du comportement alimentaire (TCA) et l’endométriose partagent des mécanismes physiopathologiques communs, impliquant des altérations de l’axe intestin-cerveau. Le but de l’étude pilote ENDONUT était de rechercher une association entre ces trois pathologies en dép...

Background: Endometriosis is a common benign gynaecological disease that affects pelvic structures and causes adhesions. Endometriosis outside the pelvis exists but is rarer. Deep endometriosis may affect organs such as the urinary bladder, ureters, bowel and sacral roots. Adenomyosis (growth of endometrium in the myometrium, sometimes explained b...

Morbidity and mortality alone are not comprehensive measures of evaluating the benefits of surgical interventions in endometriosis patients, thus, subjective patient-reported instruments are required. The 36-tem Short Form Survey (SF-36) is a Health-Related Quality of Life (HRQoL) instrument that has not been validated yet for women with endometrio...

Study Objective: To assess what degree can digestive symptoms improve after endometriosis surgery for different localisations? Design: A comparative retrospective study employing data prospectively recorded in The North-West Inter-Regional Female Cohort for Patients with Endometriosis (CIRENDO) from June 2009 to November 2018. Setting: Two referral...

Resumen La endometriosis digestiva es la localización no ginecológica más frecuente. Por tanto, los equipos quirúrgicos que tratan esta patología se ven enfrentados a ella con frecuencia. Se han descrito y desarrollado técnicas menos «radicales» que la resección segmentaria y cada vez las utilizan más equipos en la actualidad. El shaving rectal par...

Introduction: Although live surgeries are routinely included in surgical congress programs, they are the subject of an ongoing debate in terms of patient safety and teaching value. The goal of our study was to assess the risk of postoperative complications related to live surgery broadcast from the surgeon's routine theater, in patients managed fo...

Aim: To assess whether placement of a biological mesh (Permacol®) between the vaginal and rectal sutures reduces the rate of rectovaginal fistula, in patients with deep rectovaginal endometriosis. Methods: We report a retrospective, comparative study enrolling patients with vaginal infiltration > 3cm diameter and rectal involvement in two center...

Colorectal deep infiltrative endometriosis (DIE) can have a major impact on patient’s health and quality of life. Surgical treatment of colorectal DIE varies depending on the location and characteristics of the lesions, which is why the preoperative non-invasive diagnosis needs to be correct and complete. Multiple imaging methods are currently avai...

Objective To present 10 standardized and reproducible surgical steps allowing for complete excision of deep endometriosis nodules involving the sciatic nerve. Design Surgical education video. The local IRB confirmed that the video met ethical criteria required for publication. Patient consent was obtained. Setting Tertiary referral center Interv...

Objective To review prospectively the clinical characteristics of patients suffering from urinary tract endometriosis (UTE) in France, in 2017. Study Design We conducted a prospective observational multicenter study including women managed surgically for UTE in 31 French endometriosis expert centers (FRIENDS group) from January 1, 2017 to December...

Study objective: To assess whether a liberal policy of preventive stoma (LPS) reduces the rate of rectovaginal fistula in women with excision of deep endometriosis requiring concomitant vaginal and rectal sutures, when compared to a more restrictive policy of stoma (RPS), and to assess risk factors for fistula. Design: Retrospective before-and-a...

The complete excision of low rectovaginal deep endometriosis is a demanding surgery associated with an increased risk of intra- and postoperative complications, which can impact the quality of life. Given the choices of optimal surgery procedures available, we would like to emphasize that a minimally invasive approach with plasma medicine and a tra...

Study objectives To describe the surgical management and the risks of postoperative complications of patients suffering from urinary tract endometriosis (UTE) in France in 2017. Design Multicentric retrospective cohort pilot study. Setting Department of Gynecology in 31 expert endometriosis centers. Patients All women managed surgically for UTE,...

Study Objective To assess the risk of low anterior resection syndrome (LARS) between women managed by either disk excision or rectal resection for low rectal endometriosis. Design Retrospective study of a prospective database. Setting University Hospital. Patients 172 patients managed by disk excision or rectal resection, for deep endometriosis...

Ovarian cancer is one of the most common cancers worldwide, and is associated with a prior diagnosis of endometriosis in several cases. Our aim was to correlate genetic and methylation profile of ovarian endometrioid ovarian cancer and endometriosis patients. We evaluated the genetic profile of 50 ovarian endometriosis and 20 ovarian endometrioid c...

Objective To present 10 consecutive, standardized, and reproducible surgical steps allowing complete excision of deep endometriosis nodules infiltrating the parametrium and sacral roots. Design Surgical video presenting the 10 surgical steps. Local institutional review board approval was not required for this video article, because the video descr...

Introduction The aim of this study was to assess a human cadaver model of sacral plexus dissection for learning about deep innervation in the female pelvis, and the latter's relationship with deep infiltrating endometriosis. Methods This was a prospective, observational study. Eight residents in obstetrics and gynecology were tested before and aft...

Objective To provide a snapshot of the surgical management of endometriosis in French high-volume activity centers. Methods Analysis of prospectively collected data between November 2015 and May 2017 in 21 centers with a high volume of endometriosis surgery in France. Each facility could include up to 40 patients undergoing laparoscopy for endomet...

Advances in preoperative diagnostic as well as surgical techniques for the treatment of endometriosis, especially deep endometriosis call for a classification system that includes all aspects of the disease such as peritoneal, ovarian endometriosis and deep endometriosis and secondary adhesions. The widely accepted r‐ASRM classification has certain...

Ovarian endometriosis is a frequent chronic gynecological disease with an uncertain evolution regarding its progression or association with ovarian malignant lesions. The present review summarized the histological aspects, gene expression and microRNA (miRNA/miR) alterations associated with ovarian endometriosis and cancer and their possible intera...

Objective To assess the relationship between the rate of postoperative bowel fistula and surgeon experience. Design Retrospective study. Setting Two referral centers. Patients 1060 women managed for colorectal deep endometriosis by one gynecologist surgeon from January 2005 to March 2020. Interventions Shaving, disc excision and segmental color...

Study question: What is the prevalence of laparoscopically nonvisualized palpable satellite bowel nodules at or near the planned stapler site in women undergoing segmental bowel resection for endometriosis? Summary answer: Overall, 13 (25.5%) of 51 patients who underwent resection had nonvisualized palpable satellite lesions as small as 2 mm, in...

Aim To assess functional outcome and quality of life in patients with low and mid rectal endometriosis who have undergone disc excision using a semicircular transanal staple device, a procedure we have named the Rouen technique. Methods Retrospective study of patients undergoing the Rouen technique between October 2009 and November 2018. Pre and p...

BACKGROUND Endometriosis is an often chronic, inflammatory gynaecologic condition affecting 190 million women worldwide. Studies have reported an elevated cancer risk among patients with endometriosis. However, prior research has included methodologic issues that impede valid and robust interpretation. OBJECTIVE AND RATIONALE We conducted a meta-a...

Study Objective To determine the prevalence of palpable non-visualized bowel endometriotic nodules in women having a laparoscopic-assisted segmental bowel resection for large endometriotic lesions and to compare the operative findings and early postoperative complications with and without palpable non-visualized lesions. Design Observational with...

Introduction: There is increasing evidence that intermediate and long-term bowel dysfunction may occur as a consequence of radical surgery for rectal deep endometriosis (DE). Typical symptoms include constipation, feeling of incomplete evacuation, clustering of stools, and urgency. This is described in the colorectal surgical literature as low ant...

Study Objective To assess 1-year postoperative outcomes of surgery for deep endometriosis involving the sacral roots and sciatic nerve. Design Retrospective case series. Setting Three referral centers. Patients Fifty-two women. Interventions Surgery for deep endometriosis involving the sacral roots and sciatic nerve. Measurements and Main Resu...

Surgical treatment of Deep infiltrating endometriosis includes conservative or radical approaches. Conservative approach employs either shaving or disc excision, while radical approach is based on segmental colorectal resection. Long-term outcomes following either technique are comparable in regards to organ function, pain, and recurrence rates. Su...

Résumé Objectif Évaluer la relation entre le taux de fistule digestive postopératoire et l’expérience du chirurgien. Design Étude rétrospective. Centres Deux centres. Patientes Mille soixante patientes traitées pour une endométriose profonde infiltrant le rectum ou le côlon sigmoïde par un chirurgien gynécologue de janvier 2005 à mars 2020. In...

Research question Are large ovarian endometriomas associated with high pre-operative anti-Müllerian hormone (AMH) concentrations? Design Data from 332 women who underwent AMH measurement before surgery for endometriosis were prospectively recorded in a large database. Univariate analysis compared AMH concentrations in terms of the patients’ baseli...

Résumé Objectif de l’étude Évaluer si la voie combinée vaginale-cœlioscopique peut réduire le risque d’atonie vésicale postopératoire, par rapport à une approche exclusivement cœlioscopique, chez les patientes présentant une endométriose rectovaginale profonde avec infiltration vaginale étendue. Design Il s’agit d’une étude rétrospective comparat...

Objective To assess the impact of type of surgery for colorectal endometriosis –rectal shaving, discoid or colorectal segmental resection– on complications and surgical outcomes. Data Sources We performed a systematic review of all English and French language full-text articles addressing surgical management of colorectal endometriosis and compare...

Introduction and hypothesisThe aim was to develop a nomogram based on clinical and surgical factors to predict the likelihood of voiding dysfunction after surgery for deep endometriosis.Methods This was a retrospective study of 789 patients (training set) who underwent surgery for deep endometriosis with colorectal involvement from January 2005 thr...

Study question: What are the risk factors and prevalence of bowel fistula following surgical management of deep endometriosis infiltrating the rectosigmoid and how can it be managed? Summary answer: In patients managed for deep endometriosis of the rectosigmoid, risk of fistula is increased by bowel opening during both segmental colorectal resec...

Oocyte vitrification is an attractive and efficient option in the long-term management of endometriosis patients. Which women would benefit from banked oocytes when pregnancy is attempted and whether ovarian freezing should be performed before or after the surgical management of endometriosis is still debated. Based on recent data and in the absenc...

Objective Surgical management of deep endometriosis is associated with a high incidence of lower urinary tract dysfunction. The aim of the current systematic review and meta-analysis was to assess the rates of voiding dysfunction according to colorectal shaving, discoid excision and segmental resection for deep endometriosis. Data sources We perfo...